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J O Prochaska

Publications and source records attributed to J O Prochaska.

At least 55 records · Page 3Linked to original sources
PubMed1992

In search of how people change. Applications to addictive behaviors.

How people intentionally change addictive behaviors with and without treatment is not well understood by behavioral scientists. This article summarizes research on self-initiated and professionally facilitated change of addictive behaviors using the key trans-theoretical constructs of stages and processes of change. Modification of addictive behaviors involves progression through five stages--pre-contemplation, contemplation, preparation, action, and maintenance--and individuals typically recycle through these stages several times before termination of the addiction. Multiple studies provide strong support for these stages as well as for a finite and common set of change processes used to progress through the stages. Research to date supports a trans-theoretical model of change that systematically integrates the stages with processes of change from diverse theories of psychotherapy.

Aftercare↗
PubMed1992

Assessing elements of women's decisions about mammography.

We investigated motivational and cognitive processes of behavior change with respect to mammography screening. One hundred forty-two women (ages 40 and older) recruited from three worksites answered a 41-item questionnaire consisting of statements based on constructs from the transtheoretical model of behavior change. Principal-components analysis identified two factors: a six-item component representing positive perceptions of mammography (Pros) and a six-item component representing avoidance of mammography (Cons). Analysis of variance showed that Pros, Cons, and a derived Decisional Balance measure (Pros minus Cons) were associated with stage of mammography adoption. Results are consistent with applications of the model to smoking cessation. The model is also discussed as it relates to other theories of behavior change and as a general strategy for analyzing perceptual data pertinent to health-related actions and intentions for behavioral change.

Adult↗
PubMed1992

Assessing outcome in smoking cessation studies.

Outcome measures for smoking cessation are reviewed and evaluated, including 3 self-report measures and 3 biochemical validation measures. Point prevalence reflects the percentage of participants taking action, prolonged abstinence reflects those in the maintenance stage, and continuous abstinence reflects those who progress from action to maintenance without lapsing or relapsing. Biochemical assessments are primarily measures of point prevalence abstinence. The desirability of biochemical validation is a particularly controversial and critical issue. Three factors affect the accuracy of self-report: Type of Population, Type of Intervention, and Demand Characteristics. False-negative rates are generally low. Three broad issues impact on decisions to use biochemical validation: (a) alternative explanations for false positives, (b) refusal rate problems, and (c) the effect of inaccuracy on intervention assessment.

Follow-Up Studies↗
PubMed1991

Assessing how people change.

Traditional assessments of behavior change relied on discrete measures based on assumptions that changes occur quickly, dichotomously, and without relapse. People were expected to shift dramatically from smokers to nonsmokers or from unhealthy to healthy lifestyles. A stage model of change has greater potential to assess the dynamics of change with some people progressing linearly from contemplation to maintenance, others relapsing back to contemplation, and others remaining in a stage like contemplation for long periods. Stage measures provide differential predictions for the amount of progress people in different stages will make after treatment. Assessing processes of change that people apply to progress from one stage to the next can also help to explain the dynamics of behavior change.

Attitude to Health↗
PubMed1991

Treating ourselves vs. treating our clients: a replication with alcohol abuse.

In an attempt to replicate previous findings, this study compared the change processes that psychologists report using when treating clients (n = 132) and when treating themselves (n = 140) for alcohol abuse. The results essentially replicated earlier research in that employment of particular change processes varied as a function of theoretical orientation for psychologists' client change but not for psychologists' self-change. Several processes, such as stimulus control and self-liberation, were employed more often with self-change, but medication more often with clients. Five possible explanations for this pattern and a general "facilitation effect" are discussed.

Adaptation, Psychological↗
PubMed1991

The process of smoking cessation: an analysis of precontemplation, contemplation, and preparation stages of change.

Traditionally smoking cessation studies use smoker and nonsmoker categories almost exclusively to represent individuals quitting smoking. This study tested the transtheoretical model of change that posits a series of stages through which smokers move as they successfully change the smoking habit. Subjects in precontemplation (n = 166), contemplation (n = 794), and preparation (n = 506) stages of change were compared on smoking history, 10 processes of change, pretest self-efficacy, and decisional balance, as well as 1-month and 6-month cessation activity. Results strongly support the stages of change model. All groups were similar on smoking history but differed dramatically on current cessation activity. Stage differences predicted attempts to quit smoking and cessation success at 1- and 6-month follow-up. Implications for recruitment, intervention, and research are discussed.

Adaptation, Psychological↗
PubMed1991

Process of smoking cessation. Implications for clinicians.

The process of smoking cessation involves progression through five stages of change: precontemplation, contemplation, preparation, action, and maintenance. Most patients are not prepared to take action on their smoking, yet most smoking cessation programs are designed for smokers who are so prepared. Small percentages of smokers register for action-oriented cessation programs. How much progress patients make after an intervention is directly related to what stage they are in prior to intervention. The stages of change can be quickly assessed with four questions. Physicians can then be more effective with a broader range of patients by matching their interventions to the patients' stage of change. Helping patients progress just one stage can double their chances of not smoking 6 months later. Providing personalized information about the cons of smoking, asking affect-arousing questions, and encouraging patients to re-evaluate themselves as smokers are interventions physicians can use to help patients who are not prepared to quit smoking. Behavioral interventions, such as providing substitutes like nicotine gum and removing or altering cues for smoking, are most helpful for patients who are ready to take action. The use of a stage-matched, patient-centered counseling intervention can help physicians to feel less frustrated and more effective in their efforts to help a broad range of their patients.

Humans↗
PubMed1990

Relapse situations and self-efficacy: an integrative model.

Researchers studying relapse for an addictive behavior have employed two different conceptual models. Researchers concerned with typologies of relapse situations have developed a variety of discrete classes of high risk situations. Researchers who have employed a Self-efficacy approach have typically assessed different situations but scored the measure as a single general construct. Using structural modeling, this paper evaluates five alternative measurement models, representing alternative conceptualizations. A hierarchical model which integrates the previously competing models provided the best fit to the data and serves to explain a large body of previous findings. The model includes three first order constructs (Positive/Social; Negative/Affective; and Habit/Addictive) and one general second-order factor. The results were replicated across two different response formats and two different subject samples.

Adolescent↗
PubMed1990

Nonprogressing profiles in smoking cessation: what keeps people refractory to self-change?

A 2-year cross-sequential analysis of informal self-change efforts at smoking cessation evaluated the use of coping operations and the mediation of cognitive judgments among four composite profiles. Subjects (N = 544) were grouped by stage of readiness to change (contemplation, action, relapse, and maintenance) and assessed every 6 months on 10 change processes, self-efficacy, and the decisional balance between the "pros" and "cons" of smoking. Two change status profiles, contemplation to maintenance, and relapse to maintenance, were selected as exemplars of optimal linear progress; two others, chronic contemplation and chronic relapse, illustrated nonprogressing patterns in which subjects remained stuck in the same stage for 2 years. Multivariate and univariate ANOVA results indicated that nonprogressing smokers overutilize certain experiential change processes rather than underutilizing behavioral strategies, as was predicted. Implications of these results for specialized self-help interventions are discussed in the context of a comprehensive model of change for the addictive behaviors.

Adult↗
PubMed1989

The Boulder and/or the Vail model: training preferences of clinical psychologists.

This study examined the preferences of Division 12 members (N=442) for doctoral training models (Boulder,Vail, equally Boulder and Vail) as a function of the respondent's own training program and current professional activities. Fifty percent favored the Boulder model, 14% the Vail model, and the remaining 36% both equally. However, as expected, preferences varied reliably according to one's doctoral training: Only 7% of the psychologists trained in a strong Boulder tradition preferred the Vail model, while only 10% of those trained in a strong Vail tradition favored the Boulder model. Current activities also were related systematically to training preference. These results argue for a more informed and restrained dialogue on the issue, which should be guided by the light of data rather than the heat of passion.

Colorado↗
PubMed1989

Debunking myths about self-quitting. Evidence from 10 prospective studies of persons who attempt to quit smoking by themselves.

This article examines data from 10 longterm prospective studies (N greater than 5,000) in relation to key issues about the self-quitting of smoking, especially those discussed by Schachter. When a single attempt to quit was evaluated, self-quitters' success rates were no better than those reported for formal treatment programs. Light smokers (20 or less cigarettes per day) were 2.2 times more likely to quit than heavy smokers. The cyclical nature of quitting was also examined. There was a moderate rate (mdn = 2.7%) of long-term quitting initiated after the early months (expected quitting window) of these studies, but also a high rate (mdn = 24%) of relapsing for persons abstinent for six months. The number of previous unsuccessful quit attempts was unrelated to success in quitting. Finally, there were few occasional smokers (slips) among successful long-term quitters. We argue that quitting smoking is a dynamic process, not a discrete event.

Follow-Up Studies↗
PubMed1988

Processes of change in heavy and light smokers.

The nicotine addiction model is frequently used to explain the fact that light smokers are more successful in quitting smoking than are heavy smokers. According to this view, heavy smokers are more addicted to nicotine and therefore experience more withdrawal symptoms, cravings, and other difficulties when attempting to quit. However, dependence models of smoking have received inconsistent research support. In the present study an alternative explanation is offered, that light smokers employ more change strategies than do heavy smokers. Light (N = 72) and heavy (N = 247) smokers were compared on 10 processes of change known to be relevant to cessation based on previous studies. The MANOVA results indicated that light smokers outperformed heavy smokers on 4 of the 10 processes, especially on behaviorally oriented processes such as reinforcement management, self-liberation, and counterconditioning. A follow-up discriminant analysis correctly classified 82% of both light and heavy smokers. Although these results do not invalidate nicotine addiction models, they are suggestive and provide additional support for the Transtheoretical Model of problem behavior change.

Adolescent↗
PubMed1987

Stages of adolescent cigarette smoking acquisition: measurement and sample profiles.

A stage model of adolescent cigarette smoking acquisition was developed and an instrument to measure the stages was created. Internal validity was obtained based on principal component analysis, item analysis, and coefficient alpha. Three distinct components were labeled precontemplation, decision-making, and maintenance. The scales had reliability coefficients ranging from .86 to .94. External validity was obtained by relating the scale scores to measures of smoking behavior and intent to smoke. A cluster analysis resulted in nine distinct clusters, including profiles representing precontemplation, contemplation, decision-making, action, and maintenance stages. Further validity was obtained for the clusters by comparing groups on the perceived positive and negative consequences of smoking, and the derived pleasure from smoking.

Adolescent↗
PubMed1986

Self-change of psychological distress: laypersons' vs. psychologists' coping strategies.

This study investigated the change processes that laypersons (N = 270) and psychologists (N = 158) reported using to overcome psychological distress. Eighty-nine percent of the community sample and 82% of the professional sample experienced at least one episode of distress. Interpersonal relationships and willpower strategies were employed commonly in both samples; medication was used infrequently. Gender, education, and previous treatment were related to coping processes among laypersons. A comparative analysis indicated that, relative to laypersons, psychologists exhibited a larger and more varied repertoire of coping strategies.

Adaptation, Psychological↗